1. MoM is a Mothers’ Mental Health Toolkit Project Learning Video with Dr. Joanne MacDonald Reproductive Mental Health Service IWK Health Centre Halifax, NS Meet our Mom E xplore the story of one Mom and how her experience demonstrates the role of community service providers in Mothers’ Mental Health.

2. As a community service provider to mothers and young families you can create opportunities to promote and support mothers’ mental health. A mother’s positive mental health promotes the development of her child in physical growth and health, a solid self-esteem, confidence and skill in learning, emotional regulation and relationship success throughout life. M eet o ur M om MoM

3. In the series, Meet our Mom MoM, the Mothers’ Mental Health Toolkit Project team will introduce you to case descriptions drawn From the real experiences of our mental health clinicians and our Family Resource Centre partner staff. These Moms have common presentations and problems that will challenge you to define your possible role and contributions to her well being. The Moms will also provide examples of how you might use some of the Toolkit resources in your work. Have a copy of your Toolkit out for reference as we begin to Meet our Moms. You could also print off this presentation and make notes as you go. M eet o ur M om MoM

4. Sadira is a 28 yo mother new to Canada. Parenting 5 yo son, 2 yo daughter and another 6 mo old son. Mother-in-law lives with her at least half of the year. Small apartment in suburban area of large city. Husband takes bus to work for 11 and returns after 9. She has done an ESL class last year but remains mostly in her home. M eet o ur M om Sadira

5. Sadira comes off and on to your play group. She seems somewhat shy by nature but has gradually become more friendly with 1 or 2 of the mothers who’ve lived in the neighbourhood a long time. Sadira seems to them and you to be very withdrawn, her facial expression is blank, she isn’t focused on the interactions in the play room and doesn’t touch the tea she usually enjoys. She sighs frequently and once appeared tearful but quickly went to the washroom. M eet o ur M om Sadira

6. What are 3 possible mental health issues for Sadira? 1. 2. 3. M eet o ur M om Sadira

7. The Toolkit Project team identified:  Sadira seems not her usual self; quieter with a quality of low interest or sadness; could she be developing a depression?  Very little active interaction with her toddler and new baby put her at risk of distanced attachment, not typical for her.  There may be major stresses that are distracting her and affecting her function. M eet o ur M om Sadira

8. What would you like to know more about with this Mom? 1. 2. 3. M eet o ur M om Sadira

9. The Toolkit Team wondered about:  How long has Sadira lived in Canada? In this community? What were the circumstances of her immigration? Sadira has been in Canada only 18 months. She was pregnant for the 3 rd child soon after coming here and had medical problems in the pregnancy. She took her ESL course in England where the family had been before leaving Southeast Asia. Her husband is educated as a scientist at home but was laid off from his specialist job when the economy slowed. He is working on the front security desk of a large building to try to earn a living just now. She misses her mother, 3 sisters and many aunts very much. Her mother-in-law is more elderly with a lung disease problem and needs Sadira’s support. The children are too active for her to care for alone. Mother-in-law comes and goes on a visitor visa. She was training to be an accountant when they decided to immigrate for better employment opportunities. M eet o ur M om Sadira

10. 2. Does Sadira see a difference in herself? With gentle probing that she doesn’t seem like her usual self, Sadira does say she’s wondered if something is wrong, that she could be ill as she feels so tired, lacking in interest and concentration, with frequent headaches and change in her body habits, with diarrhea and frequent urge to urinate. She has gone to the doctor but he is rushed and she doesn’t fully understand what he says to her. You are not sure how mental health problems are understood or accepted in her culture and country of origin. She says these complaints started about 4 months ago when the baby was 8 weeks old. M eet o ur M om Sadira

11. 3. Are there any particular stresses on Sadira’s mind just now? Could this be simply worry? Sadira’s mother is being investigated for weight loss and abdominal pain. She looks very poorly when they Skype visit with her. One sister is worried she could have a cancer. The family’s finances are very strained. They came to Canada to better their prospects; she worries it may have been a mistake. Her husband is getting discouraged that he can’t use his education. His brother is very successful living in England. She feels helpless. M eet o ur M om Sadira

12. What could be the role for you or your organization in her mental health as a mother? 1. 2. 3. M eet o ur M om Sadira

13. Possible Roles and Contributions:  Can support and encourage her getting in to your centre more often; childcare assistance and attention will help support children’s development as you begin to help her sort out her problems.  Can discuss how to communicate to her North American trained doctor just what the new symptoms and changes are for her health.  Provide information about common mental health problems mothers in Canada experience; lessen stigma while exploring her cultural and family background openly, without making assumptions. M eet o ur M om Sadira

14. How might you use the Toolkit resource with Sadira? Pages 16 & 17 are checklists for common symptoms and link body health to mental health. M eet o ur M om Sadira

17. She may need help from an English speaker to write out her concerns to give to her doctor. Page 19 is Preparing for my Medical Appointment. M eet o ur M om Sadira

19. Pages 118 & 119 on Signs and Symptoms are a review for you of some of the presentations of mental health problems. Page 121 is a Mental Health Check-up Checklist that you could go over and help interpret for Sadira. M eet o ur M om Sadira

23. Perhaps you are not sure that Sadira understands what you are trying to discuss with her. Pages 132 and 133 discuss some simple approaches to communication with newcomers. Page 135 has simple facial expressions that are visual aids to describing mood. M eet o ur M om Sadira

27. You seek out newcomer services in your area and receive Sadira’s consent to work with an interpreter. The interpreter helps her complete the Edinburgh Postnatal Depression Scale, page 139-140, a screening tool she can then take to her family doctor. She screens as having a likely Postpartum Depression. M eet o ur M om Sadira

30. The family doctor does diagnose Major Depression and starts Sadira on an antidepressant you hope is safe for the breastfeeding baby. There is a long wait for mental health services though. While Sadira is waiting for mental health assessment you use the Recovery Plan Template pages 149 & 150 to look at possibilities that support any person’s recovery. M eet o ur M om Sadira

33. Key Points when working with newcomers:  Often most respectful to ask if you can ask about the newcomer’s experience; many immigrants and refugees come from traumatic experiences where it may not have been safe to speak.  Talking about what is typical for most mothers can be an effective way to reduce the stigma of having a mental health problem and allow the newcomer mother to internally compare her experience to what you describe.  Not all symptoms a woman experiences are the result of the many adjustments for newcomer mothers. Postpartum Depression has been found in 10% of new mothers in many different countries, cultures and economic levels. Don’t forget to support screening for illness, physical and mental, and help newcomers navigate the Canadian health care system. They may not know they can take the lead in communicating with their health care provider. M eet o ur M om Sadira

34. Other Resources: www.postpartum.netwww.postpartum.net – online source of education from a woman driven advocacy group in the United States; helpful stories from real women; some advertising included on site; not-for-profit organization www.cic.gc.cawww.cic.gc.ca – Canada’s national government website on Citizenship and Immigration www.kidsnewtocanada.cawww.kidsnewtocanada.ca – The Canadian Pediatric Society website with helpful terms and explanations of possible barriers and tips to healthcare for newcomer families. Includes a link to Cultural Competence including Sick Kids Hospital modules on Parenting Across Cultures M eet o ur M om Sadira